National Patient ID System: Debate Stoked

Hoping to spark a national conversation on information exchange, a prominent health IT advocate has started a WhiteHouse.gov petition to have Congress lift ban on HHS national patient identification system.

6 HIE Vendors: How They Measure Up

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A well-known health IT advocate and consultant has started a petition on WhiteHouse.gov asking Congress to lift its prohibition on the U.S. Department of Health and Human Services (HHS) setting up a national patient identification system.

The petition, posted this week on the official White House website, calls on a rollback of restrictions that have been in place for nearly a decade and a half. "Congress should permit HHS to develop standards, especially if this could increase efficiencies and prevent medical errors," the petition states.

The original Health Insurance Portability and Accountability Act (HIPAA) legislation from 1996 called on HHS to develop a system of unique patient identifiers to help promote privacy and security of personally identifiable health information. But federal appropriations legislation for fiscal year 1999, passed in 1998, denied funding for HHS to implement a patient ID program.

Though the Obama administration officially remains opposed to a national patient ID, some in the health IT industry believe the vision of a nationwide network of interoperable electronic health records (EHRs) is unrealistic without a standard means of locating and authenticating records.

"We're trying to apply a 1990s policy framework to a 21st Century technology problem," said the petition's creator, Brian Ahier, a part-time health IT "evangelist" at Mid-Columbia Medical Center in The Dalles, Ore., who also consults on health IT issues. "Right now, over three-quarters of Congress was not a member in 1998 when that law was passed," he added.

EHR vendor Cerner is among those now advocating for unique patient IDs. The Healthcare Information Management and Systems Society (HIMSS) also is calling for at least a national patient ID matching strategy. HIMSS said such an approach, which does not necessarily include a unique ID number for each person, would better facilitate health information exchange (HIE) and improve patient safety.

Ahier is a board member of the Oregon chapter of HIMSS and serves as president of Gorge Health Connect, an HIE in north-central Oregon.

By Thursday afternoon, the petition had fewer than 100 signatures, but Ahier said he does not expect to meet the listed goal of 100,000. The White House promises an official response to any petition that receives at least 100,000 signatures within 30 days -- though the threshold was 5,000 and later 25,000 during Barack Obama's first term as president.

"Direct contact [with the Obama administration] is more effective anyway," Ahier said. He and his allies have had plenty of contact with the HHS Office of the National Coordinator for Health Information Technology and other Washington insiders. He also said social media is helping to spread the idea of re-opening the dialogue about patient identification.

Ahier described the petition as more of a "firestarter" to urge Congress to reevaluate its 1998 decision. "We've hamstrung our policy development at HHS with this imposition," Ahier said of the funding ban. "Not everyone agrees, but at least we're having the conversation."

A 2008 report from Rand Corp. said that the prohibition against unique patient IDs would hinder development of a nationwide system of interoperable health records. While that report garnered headlines at the time, it did not spark much momentum toward changing the law.

As large healthcare providers test the limits, many smaller groups question the value. Also in the new, all-digital Big Data Analytics issue of InformationWeek Healthcare: Ask these six questions about natural language processing before you buy. (Free with registration.)

I for one simply don't see any need for a uniform national patient identifier system run directly by HHS itself, despite the accelerating adoption of electronic health records and continued involvement of government in healthcare. Individuals should own their own health identification. The government should be, if anything, a consumer of these identifiers, and perhaps a regulating entity, not a holder and manager. There's no reason that many of the principles underlying the public-private National Strategy for Trusted Identities in Cyberspace should not carry over into the healthcare space.

The potential for abuse is there - but the legal guardrails are in place - and do work.

A large company I highlighted last year (5,000 employees) has engaged their entire employee base (and families) with healthcare services - very directly. It's definitely more of a partnership - but that's also the model that we need for healthcare more generally around true "patient engagement."

Companies that abuse that privilege will find it (ultimately) more and more challenging to find the best talent with policies of exclusion - rather than policies of inclusion.

In the meantime - we should be looking for ways to report abuses on the part of companies that ask inappropriate questions during an interview process. I know my eyebrows are raised when I hear that a company is asking for medical records as a part of an interview process.

HIPAA is flawed - and we should logically revisit it relative to the new information (and internet) age - but much of what it was designed to protect is based on an NPI - which was originally a part of the legislation. Trouble is - they took out the NPI - and left just the onerous rules and regulations. As it relates to HIPAA - it's the worst of all possible worlds.

The wierd part is that an NPI isn't really a new request - it was part of HIPAA to begin with - and was removed. In that sense - all we're asking for is for legislation to put it back in (or in the case of the petition - to allow ONC to at least research it).

I'm not naive about the challenges of an NPI - it will take years - if it's ever adopted. It isn't a panacea or an easy solution - far from it. The value, however, is enormous both in lives and $'s saved.

Thanks to Brian for picking up the banner - and to Neil for writing about it. I've written about it too here: http://hc4.us/128bytes

With greater focus shifting towards creating a nationwide HIE, the debate regarding a national patient ID system will garner more attention. As stated in the article, the creation of a nationwide HIE may be hampered by the fact that there isnG«÷t a standard in place to identify patients. I agree that even though a patient ID may not be the safest or best option, at least a national patient ID matching system should be in place.

Before the ban can be lifted there need to be better privacy protection laws over this information. I applied for a job at a prospective employer that requested my medical records before making me an offer. There are no laws prohibiting this request. Once this information is in a national database there will be all kinds of abuses.